1356853352 NPI number — COURTNEY RENEA BRIGGS CRNA

Table of content: COURTNEY RENEA BRIGGS CRNA (NPI 1356853352)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356853352 NPI number — COURTNEY RENEA BRIGGS CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRIGGS
Provider First Name:
COURTNEY
Provider Middle Name:
RENEA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
EARL
Provider Other First Name:
COURTNEY
Provider Other Middle Name:
RENAE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1356853352
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/28/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1009 NOVUS DR STE 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JOHNSON CITY
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37604-8237
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-283-0776
Provider Business Mailing Address Fax Number:
423-968-5697

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1009 NOVUS DR STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JOHNSON CITY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37604-8237
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-283-0776
Provider Business Practice Location Address Fax Number:
423-968-5697
Provider Enumeration Date:
10/30/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  169138 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: 0000024181 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: Q00385A , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 116290000 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".